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Budget fight looms over changes in Medicaid mental health in Michigan

Calculator with a budget

As the state of Michigan prepares for the upcoming budget fight over proposed changes to Medicaid and mental health in Michigan, advocates and lawmakers have expressed concern and opposition to the governor’s proposal to shift behavioral health management responsibilities to Medicaid health plans.

“How we should deliver mental health services in Michigan is really a crucial issue. It’s a core question that is still on the table.”

 

Marianne Udow-Phillips

September 27th, 2019

“Mental health advocates are pressing Gov. Gretchen Whitmer to veto budget provisions they say could “irreparably damage” care for 300,000 low-income people in Michigan with serious mental illness or developmental disabilities,” writes Ted Roelofs for Bridge Michigan.

“While overshadowed by other budget showdowns, their warnings are the latest in a long-simmering skirmish over who should manage care for these individuals.

Under a plan first proposed by GOP Gov. Rick Snyder in 2016, Michigan was to privatize its $2.4 billion public mental health system by turning over state funding to Medicaid physical health plans as part of a plan to integrate physical and mental-health services for low-income patients.

Proponents said that merger would save millions of dollars while improving care. Critics said the switch would leave care for the mentally ill and disabled in the wrong hands.”

READ THE STORY HERE

CHRT Board member named University Distinguished Professor

John Z. Ayanian, received Distinguished University Professors honor

John Z. Ayanian, received Distinguished University Professors honor

The University of Michigan has recently recognized the outstanding accomplishments of six faculty members, who have been appointed as Distinguished University Professors. This distinguished title is granted to exceptional individuals who have displayed remarkable scholarship and creativity, while also making a significant impact in their respective fields. It is an honor that reflects the hard work, dedication, and excellence that these professors have consistently demonstrated throughout their careers. One of them is Dr. John Z. Ayanian. 

John Z. Ayanian, Alice Hamilton Distinguished University Professor of Medicine and Healthcare Policy. He also is the Alice Hamilton Collegiate Professor of Medicine, director of the Institute for Healthcare Policy and Innovation and professor of internal medicine, Medical School; professor of health management and policy, School of Public Health; and professor of public policy, Gerald R. Ford School of Public Policy.

July 18th, 2019

Six faculty members have received one of the University of Michigan’s top honors as Distinguished University Professors.

The Board of Regents approved the appointments on July 18. They are effective Sept. 1.

Recently appointed DUPs are invited to give an inaugural lecture.

READ THE UNIVERSITY RECORD STORY HERE

Reduce administrative burden of work rules to prevent mass health coverage losses, by Udow-Phillips & Shaefer

Udow-PhillipsHealthcare is an essential human right, and the ability to access it without undue hardship is critical for individuals and society as a whole. Unfortunately, administrative burdens and complex work rules often make it difficult for many to maintain health coverage. However, according to a recent proposal by Udow-Phillips and Shaefer, there is a solution to this pressing problem. They propose streamlining processes and reducing complexities in order to prevent widespread loss of health coverage.

“In February 2019, legal and consulting firm Manatt estimated that Michigan work requirements would result in the loss of coverage for between 61,000 and 183,000 people.”

Marianne Udow-Phillips, Luke Shaefer

July 15th, 2019

Medicaid work requirements are scheduled to take effect in Michigan on Jan. 1.

Yet a recent study from Arkansas adds to mounting evidence that such requirements can result in major losses of health coverage without meaningfully increasing work effort.

As the Michigan Legislature continues to deliberate on the 2020 fiscal year budget, this study should spur action to ensure that Michigan doesn’t follow the same path as Arkansas.

During Michigan’s legislative debate on Medicaid work requirements, we raised concerns about the potential for major health coverage losses; concerns based on the record of such requirements on the nation’s cash welfare program, and on some recipients of food stamps, now called the Supplemental Nutrition Assistance Program. Yet at the time there was no direct evidence about the impact of Medicaid work requirements because no state had ever implemented them.

As Michigan prepares to implement these requirements on January 1st, it is crucial that policymakers take heed of these findings and prioritize the accessibility and affordability of healthcare for all. By reducing work rules and streamlining processes, we can help ensure that individuals can obtain and retain the coverage they need.

READ THE ENTIRE CRAIN’S DETROIT BUSINESS ARTICLE HERE

CHRT and Detroit Health Department collaborate on new staff fellowship program

Several people in a meeting

In 2018, with support from U-M Poverty Solutions and the DMC Foundation, the Detroit Health Department worked with CHRT to develop a new fellowship program for front-line staff–one designed to build specific skills and knowledge that would positively impact public health service delivery in Detroit. Here, we delve into the details of this initiative, exploring its inception, goals, and the impact it has had on the city’s public health landscape.

The fellowship, which graduated its first cohort of fellows this week, engages DHD personnel who work in a wide variety of departments and roles such as maternal and child health, environmental health, lead poisoning prevention, child and adult immunizations, and more.

Interactive sessions led by CHRT staff, including Executive Director Marianne Udow-Phillips, are designed to build knowledge in systems thinking, data analytics, policy engagement, and communications so that new skills and practices can be applied by DHD staff in their daily work. Sessions also include guest panels and presenters, including Dr. Jack Billi, a Michigan Medicine expert on quality improvement and lean process management, and Representative Abdullah Hammoud, a vice chair of the Michigan State House of Representatives Appropriations Subcommittee on Health and Human Services.

The interactive curriculum covers public health policy, health and human services integration, project management, program evaluation, community coalition-building, and more.

The first cohort of DHD Fellows, pictured here, completed the 14-session program earlier this week. A second, 20-person cohort of DHD staff began their fellowship in April and will graduate in October of this year.

To improve health, boost Medicaid dental reimbursement rates, by CHRT Fellow Dr. Romesh Nalliah

Dr. Nalliah calls for higher Medicaid dental reimbursementDental care is a vital component of overall health, yet it remains a challenge for many individuals, especially those who rely on Medicaid for their healthcare needs. Dr. Romesh Nalliah, a CHRT Fellow sheds light on the pressing issue of low Medicaid dental reimbursement rates and their impact on oral health outcomes. 

“Michigan’s outdated, 29-year-old Medicaid reimbursement rates are a vestige of a different time, and a significant factor in a structure that can encourage inefficient use of healthcare resources and result in costly, suboptimal dental care for many people.”

 

Dr. Romesh Nalliah

June 25th, 2019

We know that preventive dental care services are highly valued and sought after by consumers. Nevertheless, every year about 440,000 Americans covered by Medicaid end up in the Emergency Room with a dental complaint, costing Medicaid over $310 million annually. The average ER charge for a dental emergency is $760, the average charge for a dental examination, routine x-rays and cleaning is a little less than $235.

While research shows that there are far fewer medically-related hospital admissions for those who regularly receive preventive dental care, and that individuals having insurance are much more likely to seek preventive care and have better clinical outcomes, too few dentists participate in Medicaid to resolve this imbalance. So, despite overwhelming evidence that preventive dental care costs less and keeps patients healthier, the overreliance on costly, taxpayer-funded emergency room dental care continues nationally, and in Michigan.

READ THE FULL STORY HERE

Michigan pilot project can help reduce ER overcrowding and improve mental health treatment

Overcrowded ER

Overcrowded ERER overcrowding is a significant challenge facing healthcare providers in Michigan.  In Bridge Magazine’s Health Watch series, Ted Roelofs looks at how a federally funded project — administered by CHRT on behalf of the Washtenaw Health Initiative — coordinates multiple health, mental health, and human service organizations to focus on people with substance abuse and mental health issues who are frequent emergency department patients. The project looks to match patients with the right medical or social services treatment while simultaneously reducing the use of costly, labor-intensive emergency medical services.

“So far, roughly 35 percent of the frequent emergency room visitors studied in Washtenaw and Livingston counties were found to have drug or alcohol disorders and 40 percent were receiving mental health services,” writes Roelofs, who also notes the tenuous economic status of many frequent emergency room users is a complicating factor that “can mean uneven access to transportation, housing or food, all of which can prove obstacles to effective health care.”

“I see the emergency room as symptomatic of a lot of societal gaps and challenges,” says Jeremy Lapedis, project coordinator.  In the article Lapedis details some of the early successes and challenges encountered by the project and ties those successes back to timely intervention and reduced emergency room use.

READ THE FULL BRIDGE MICHIGAN STORY HERE

Hospital Finances Improve After Medicaid Expansion, But At Whose Expense?

Hospital Finances Improved

Hospital Finances in a graph, beside a laptop and stethoscopeMedicaid expansion has been a subject of ongoing debate and analysis since its inception. While it has undeniably led to improved financial conditions for hospitals, the question remains: at whose expense? Today, we will delve deeper into the NPR article titled “Hospital Finances Improve After Medicaid Expansion, But at Whose Expense?” and explore the complex dynamics at play.

The Upside: Improved Hospital Finances

A significant benefit of Medicaid expansion is the reduction in uncompensated care for hospitals. Healthcare institutions have benefited from Medicaid expansion because it increased the number of insured patients. It has brought financial stability and allowed hospitals to reinvest in their facilities and services, ultimately benefiting their surrounding communities.

The Downside: Cost-Shifting and Potential Consequences

It is important to note, however, that this financial improvement has had unintended consequences. As a result of Medicaid expansion, other stakeholders in the healthcare system may bear the burden of its financial gains. Hospitals negotiate higher reimbursement rates to compensate for reduced Medicaid payments on behalf of private insurers and individuals with private health insurance. As a result, private insurance premiums have increased, potentially burdening individuals and businesses.

It is undeniable that Medicaid expansion has improved the financial outlook for hospitals, providing them with stability and the ability to invest in their services. It is important, however, to examine the unintended consequences, such as cost shifting to private payers, and implications for access to care and quality of healthcare. The long-term success of the healthcare system depends on achieving an equitable and fair balance between hospitals and other stakeholders.

READ THE FULL STORY HERE